Tuesday, April 10, 2012

the "birth control" debate

Today I'm here to talk about the birth control issue, a debate that's clouded with partisan rhetoric on both sides. I hope to discuss the issue, not from any partisan viewpoint, but instead from the viewpoint of a reasoned and reasonable individual with real world experience in all aspects of making and implementing decisions of this kind and dealing with their consequences.

I am qualified to comment on this issue because I've been a policy analyst, a legislative analyst, and I've also personally crafted legislation that has passed into law. Obviously, I've worked in positions of responsibility, positions of public trust where my judgement was relied upon to serve the interests of my community, the state in which I reside, and our nation. I've also held a party office within the Democratic Party. Under those auspices, I've helped to develop and implement electoral strategies.

I have a long history, not only in government, and in party politics, but also in organizing. I was a community organizer long before President Obama made the position seem to be a fashionable one. I've earned my stripes.

I'm not attorney with a well paid position to fall back on, most of my life I've been the guy in the trenches. I didn't just go door-to-door with petitions etc. myself, for over a decade I trained others how to do it, some days bringing them along while I danced door to door myself.

I fought for equal rights and for equal pay. I've battled for civil rights, community rights, reproductive rights, senior rights, disabled rights, not to mention the right to know.

So you'd think I'd be a very natural ally for the advocates in the ongoing debate on whether birth control should be provided free of charge by insurance companies in the United States for all enrolled individuals who request the drugs. If you made that assumption, you'd be wrong.

I don't care what any candidate is saying on the issue, I don't care about talking points or gender politics, and I'm also here to tell you this isn't really an issue about women's rights, nor is this issue about religious rights. Folks, this isn't an issue at all!

It's all a gigantic smoke screen, it's a circus show. It's entertainment and a distraction and really nothing more. All sides are guilty of making it such, in all honesty they all know it's a debate over nothing. They like debating nothing, and they absolutely love all the sound and fury this debate elicits from the "faithful".

Conservatives are frothing at the mouth, rabid with the thought that the government might somehow use a drug benefit to erode their religious freedoms, not to mention undermine the entire free enterprise system. Liberals are no better, as anyone who stands against this notion of universal birth control is labeled a traitor against women, a chauvinist, or perhaps one of the evil cabal hell bent on sending women back to the dark ages.

If you are feeling anything akin to any of those emotions, I'd ask you to take a deep breath and keep reading. If you are feeling more neutral, I'd like to commend you. Now let me proceed.

Before I commented anywhere on this issue I asked my wife, a Canadian, about birth control in Canada. Now everybody should know up front that Canada has a form of Universal Health Care we here in the US often call "Single Payer" - all Canadians basically get government coverage for all standard medical care, it's universal (everyone is covered) and the government acts as the insurance provider (single payer) . . .

Liberals usually love single payer health care systems, many were disappointed that Obamacare didn't at least include a nod to some kind of single payer system (the government option) while most Conservatives shudder at the thought that any part of health care might become a government function.

Well folks, we already have had years of a form of single payer health care, a hybrid, for pretty much my entire life. It's called Medicare. Would it confuse you if I told you that's also the name of the single payer system in Canada, Medicare, only there you don't have to wait until you are 65 years old to get it. Nobody dies in Canada waiting to get on Medicare, because they are born into the Medicare system.

Like I said, Heaven for liberals, and Hell for conservatives. So how does the Liberal Heaven Canada provide for birth control? Does everybody get it for nothing?

Not exactly.

There are some things Canada does differently regarding prescription drugs that have important side effects in controlling prices, but the simple answer here is that nobody gets a government guaranteed prescription drug benefit. It doesn't exist.

That's right, Canada, with Universal Health Care for all, the model for many liberal and left leaning health proposals, a system I've advocated for, that my wife has lived under and knows intimately, does not provide any prescription drug benefits for it's citizens. If you really want, you can buy it on the private market, but nobody Serafina ever knew did so. When folks in Canada need a prescription, they pay for it out of pocket.

Now there is a group here in the US that has a guaranteed prescription drug benefit available, Senior Citizens and the disabled, folks who get Medicare. For a small monthly fee they can get prescription drug coverage that guarantees them affordable co-pays. Well, affordable is a relative term, but a $45 co pay for a month's supply of name brand drugs is common under Medicare Rx.

Low income Medicare recipients can qualify for further reductions in cost, but they almost always have to pay a co-pay of some kind, even for generic prescriptions. When push comes to shove, nobody I know here in the US gets any prescription drug free, there's always at least a nominal co-pay.

With that background, I think it's safe to move to the actual topic of this post. The $200,000 question . . .

"Is it sound government policy to require insurance to cover birth control and provide it for recipients free of charge?"

Here's where I get myself into hot water, because I'm going to dismiss the arguments of both the left and the right. I'm going to start with the arguments of the conservatives and the religious right, in this case they are neither religious nor are they right.

I'm rather sure the words - "birth control is a sin" - never came from the mouth of Jesus Christ. It's certainly not stated as such anywhere in the 10 Commandments. I'm going to alienate the entire Catholic Church by saying that prohibitions against birth control are a man made invention, pure and simple.

And please don't quote prohibitions against killing, that's a big smoke screen. Preventing conception is not a form of murder, unless you'd like to take the position that all male masturbation is mass murder. Wet dreams would be involuntary manslaughter under that line of reasoning, obvious silliness.

The Catholic Church makes a mockery of itself by saying that there is an allowed form of birth control (rhythm method), and by saying that there are "just wars" (killing is ok some of the time!) - Both positions are mutually exclusive when taking the moral high ground.

Here is a pretty simple viewpoint free of all ambiguity. Either birth control is wrong, or it isn't . . . either killing is wrong, or it isn't . . . The Catholic Church can't have both ways without becoming obvious hypocrites.

Furthermore, our country was founded on the principles of separation of church and state. I certainly oppose the Government imposing any regulation or rules on our right to worship. The two entities should be separate and distinct.

Health insurance and worship are two other things that should be separate. It's not that I'm opposed to companies which are faith based, but there's a fundamental problem when we combine faith with modern health insurance. The catch being that Government has the right to regulate commerce, and insurance is commerce, and there's no way faith based insurance should be exempted from regulation.

There's a simple solution here, religious groups who do not wish to be regulated can stay out of the insurance business. When they enter the insurance world, they are entering a regulated commercial realm where government regulations are commonplace, they must then accept that business is regulated, even if faith is not.

See, this isn't that hard folks!

We've already established that a government should not have the right to dictate to a faith, but that when that faith enters the business realm, where government regulation of commerce is a long accepted practice, they need to accept that they will then be subject to business regulations just the same as everyone else.

Now comes the part where I alienate everyone else, where I say that despite the governments right to regulate commerce and dictate rules to the business world, that it is absolute stupidity to give anything away for free.

Now the truth is we all know there's no such thing as a free lunch. So, in effect, part of the problem is human nature, when something is free it creates a psychological problem where it's automatically devalued in our minds. Free things get tossed in the trash unused, as they have no obvious intrinsic value.

It's just bad policy to give anything away for free.

Even with Medicare, Grandma pays a copay for her blood pressure drugs, her cholesterol drugs, and her diabetes medications. Persons with disabilities also pay co-pays for their prescriptions drugs. It's only fair that everyone pay some kind of nominal fee for their prescription drugs, it helps assure that the drugs have a value in their mind and will be taken, and it also helps to offset the drug's actual cost.

And lest be totally honest here. Birth Control isn't an expensive drug. I looked at Planned Parenthood's website, and they say the average cost of a month's supply of birth control pills is between $15 and $45 dollars. That happens to be exactly the price range of Grandma's name brand cholesterol drug under the most common Medicare drug plans.

So I ask, in all earnestness, to the strident women who have attacked me elsewhere when I have attempted to tackle this issue, why do you think that your reproductive freedom is more important than the health of your Mother's (or your Grandmother's) heart? Why do you believe birth control should be absolutely and totally free to you, but that it's ok to ask little old ladies to pay for their lifesaving drugs?

Before somebody starts jumping up and down saying, "Grandma's drugs should be free too!" I'm going to ask for deep breaths again before I point out that our country can barely afford the benefits being given to Grandma right now. Medicare and Medicaid costs are exploding, at least in part because of the government's decision to give Grandma prescription drug benefits back in 2006. Grandma and Grandpa's Medicare Rx benefit was never actually funded, as we were too busy fighting foreign wars and cutting taxes to pay attention to details like paying for the health benefits our government was offering.

Before somebody else starts jumping up and down saying, "Grandma's pays a premium for her coverage so it's not government subsidized . . . " - I'm going to ask you to get a clue! Do you really thing that the $35 a month Aunt Elsie is paying to AARP-UHC for a Medicare Rx coverage is paying the actual cost of her insurance? (I'm falling out of my chair laughing here . . . ) Not even close!

A huge government subsidy is going to AARP-UHC to make sure they don't lose money covering Aunt Elsie, Uncle Bob, Grandma, and Grandpa. If those 4 folks are all getting their health care coverage from a Medicare Advantage Plan (which bundles standard medicare and Medicare Rx together) it's my understanding that the government subsidy is in the range of $1000 per person per month.

So just 4 of your relatives could already be costing taxpayers $48,000 a year in health insurance subsidies, and that's with Uncle Bob still having to pay a co-pay of between $5 and $45 for a month's supply of most drugs! Can you imagine how much more that bill to taxpayers would be if we told Aunt Elsie that the 10 prescriptions she takes every day before breakfast were going to be totally free?

And, in the end, this whole debate is a terrible distraction from the real problems our nation faces. Giving away birth control pills is not going to address the huge economic crisis we face. Huge numbers of people are unemployed, we've suffered a real estate bubble and a mortgage crisis that threatened make our financial systems crash and burn. Free birth control isn't going to solve that either . . .

Out nation's leaders' on both sides of the proverbial aisle, are quite satisfied with having a debate over a non-issue. Such a debate distracts us from the real problems we face. Most of the problems we face as a nation are a direct result of misbegotten government policies from the last two decades. Many of the individuals responsible for making those terrible decisions still remain in power.

If the public held elected officials accountable for the mess our country is in, said elected officials would lose their position and authority. I don't know of anyone who's begun to experience the privileges of power who then was in a hurry to give them up. Even former Senator Paul Wellstone, a liberal bastion and perhaps the strongest voice in the Senate coming from the left before a tragic plane crash, broke his initial promise to serve only a single term.

I met Paul Wellstone just after he was first elected but before he was sworn into office. I spent the better part of a day with him, chauffeuring him around the St Louis region prior to a fundraiser I'd helped to organize. The organization I worked with had brought Paul down to be the keynote speaker for an annual event we held in the MetroEast region (the Illinois side of St Louis area.)

Paul confided in me that he only wished to serve a single term, then he planned to retire and write a book about activists like myself. I got to know the Senator well enough that I was given a standing invitation, not only to visit him in Washington DC, but to stay at his personal residence as his guest.

That book was never written, as Paul died while serving his second term in the US Senate. It's sad to me how the trappings of power and their allure can find ways to get even the greatest of men to break their promises, ways to have them justify their new found desire to stay in power. Once that power has been achieved, the allure is just too great . . .

Nobody in a position of real power is going to tell you that the birth control debate is a distraction, nobody who aspires to power is likely to say so either, there's too much to loose and everything to gain by going along with the debate. This debate stirs up the "faithful" on both sides of the question, it's designed pure and simple to motivate the "base" activists for both parties.

The birth control debate is an electoral cattle prod, it's a tool designed to keep everyone moving in the direction both parties mutually desire. But please think about this for a moment . . .

What is more important?

Is it a $30 prescription drug?

Or is the fact that a huge percentage of our country is out of work and neither party has any kind of viable plan to create the millions of jobs needed for the depression/recession to actually end?

In my eyes the answer is simple . . .

I hold this truth to be self evident - If everyone in this country had a well paying job, there would be no debate necessary about a $30 prescription drug.

I think that the problem is that Viagra has been covered by insurances for awhile and birth control is not always covered. I don't think any of it should be free but if one is going to be covered the other definatley needs to be. Seems just a little sexist. Also the cost of no birth control coverage is awfully high for everyone involved. Respectfully, DJ

The state I live in long ago mandated that birth control be covered, and I've have no quarrel with such a mandate. I should have been more clear about that in my essay.

If there is a medical necessity for birth control, then I see no problem with insurance covering it. My big problem is the demand that birth control be available free, which is the strident position of the liberals.

The thing is - a fair co-pay for birth control would be similar to the co-pay senior citizens pay under Medicare Part D for their blood pressure, cholesterol, and diabetes drugs - $15 to $45 dollars - and that's already the average cost of birth control pills according to Planned Parenthood . . .

Involving insurance in the equation simply adds an extra middle man and more cost for everybody!!!

As for the cost of no birth control coverage being too high, I think that is a false argument. For starters, condoms are cheap and effective, and they also come with the side benefit of preventing the spread of many sexual diseases. Seriously, it's not that hard to "wrap that rascal"!

More focus on condoms (as opposed to hormone based drugs) is cost effective and also is a public health boon - so once again the birth control debate is the wrong discussion at the wrong time . . .

When it comes down to insurance coverage for Viagra, I don't personally agree that it should be covered by insurance, but dragging erectile dysfunctional pills into the debate is false logic. If you have a problem with Viagra being covered by insurance, fight that, don't use it as justification for other drugs to be covered.

Furthermore . . .

My ex lied about back pain (counselled by doctor) to get her breast reduction surgery - all paid for by insurance. I'm not upset that breast reduction surgery is covered for women but not for men . . . men get saggy breasts too ya know - but if I went to my doc and asked for a surgical solution - I'd be laughed out of the office!

"Tit for tat" arguments are false logic, it's apples and oranges in a way, and it forwards the agenda of people who wish to stress the differences between sexes, who have a stake in the so called "battle of the sexes".

I've got news for folks there too, smart people, real progressives, now realize that the gender wars were also a distraction forwarded by individuals with real agendas against the so called opposite sex.

Gender isn't a polarity, it's a spectrum. There aren't two genders, as there are varied forms of gender expression, and people can change their so called "gender" today. If you are a member of Fetlife, for instance, you already know that there are more than two available choices for gender . . .

So, for my way of thinking, any argument that's men vs women is inherently archaic, not to mention elitist. It assumes that there are only two gender roles that are available and/or appropriate. People who are progressive and educated in terms of gender roles know that limiting ourselves to only two choices for sex expression leaves huge numbers out of the conversation.